Basic Information
| Provider Information | |||||||||
| NPI: | 1780625137 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEAK | ||||||||
| FirstName: | LORI | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 815 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FLOYD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240913750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407455005 | ||||||||
| FaxNumber: | 5407455004 | ||||||||
| Practice Location | |||||||||
| Address1: | 430 S LOCUST ST | ||||||||
| Address2: | |||||||||
| City: | FLOYD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240912322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407455005 | ||||||||
| FaxNumber: | 5407455004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 05/08/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305005662 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 284203 | 01 | VA | SOUTHERN HEALTH | OTHER | 137660 | 01 | VA | BC/BS ANTHEM | OTHER | 2429864 | 01 | VA | UNITED HEALTHCARE | OTHER | 2281002 | 01 | VA | FIRST HEALTH | OTHER | 364553080 | 01 | VA | TRICARE | OTHER | P00194716 | 01 | VA | RAILROAD MEDICARE | OTHER | TN0100 | 01 | VA | JOHN DEERE HEALTH | OTHER | 7559448 | 01 | VA | AETNA | OTHER |